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Two experts shape the future of respiratory medicine

3 October 2017

Two experts at Royal Brompton & Harefield NHS Foundation Trust have been called on to help shape the way different respiratory conditions are diagnosed and treated, at home and abroad.

Professor Andy Bush, consultant paediatric chest physician, has co-edited a special commission from medical journal the Lancet, which draws together research and opinion from around the world to challenge doctors to think differently about the way they diagnose and treat asthma.

Dr Nick Hopkinson, reader in respiratory medicine and honorary consultant physician at Royal Brompton, has been appointed to the National Institute of Health and Care Excellence (NICE) panel charged with reviewing the new national guidelines on chronic obstructive pulmonary disease (COPD), due for publication next year.

“Deliberately controversial”

Professor Bush teamed up with colleague Professor Ian Pavord from the University of Oxford to create the Lancet Asthma Commission, and says the aim of the publication from the outset was to be provocative and challenging.

He explained: “It’s meant to be a controversial document, meant to shake people up.

“We feel that asthma care has stalled. There is no doubt that a lot of asthma is easy to treat with the right medication and the right advice. However, this has bred complacency: anyone can diagnose asthma and anyone can treat it. But we should be thinking more about curing it.

“We want doctors, researchers and pharma to realise that we don’t want more steroids: what we need is a way of stopping the march of asthma. We know that if the lungs are damaged by the time children start school, they will never achieve full adult lung function, and their risk of developing COPD later on is elevated. There is a window between the ages of one and three, when symptoms start and the lungs begin to scar, and we should be exploiting this window and doing much more to protect young lungs.”

The Commission was officially launched at a joint Lancet - European Respiratory Society symposium in September at the Milan Congress, the biggest respiratory meeting in the world, and was the subject of editorials in its official publication, the European Respiratory Journal, as well as The Lancet itself.

Professor Bush added: “Our contributors are acknowledged experts, but they are also not afraid to be provocative. We are being deliberately controversial because we are challenging clinicians around the world to think about how they diagnose and treat asthma, and to respond to us if they think they have a better idea.”

Scrutinising national guidelines

Dr Nick Hopkinson, the Trust’s clinical lead for COPD, has been sought to ensure that the latest national guidelines on diagnosing and managing this group of severe lung diseases, which includes emphysema and chronic bronchitis, are based on the right evidence.

The National Institute for Health and Care Excellence (NICE) is the non-departmental public body responsible for developing official guidelines for health and social care professionals, to ensure consistent standards of care across the country.

The key aim of its COPD guidelines is to help people receive a diagnosis earlier, so they can benefit from treatments to reduce symptoms, improve quality of life and keep them healthy for longer.

The updated guidelines are due to be published next year, and because they will set the standard across the country for the foreseeable future, it is vital that they are reviewed and approved by a panel of leading experts, to which Dr Hopkinson has been appointed.

He said: “There are 1.3 million people in the UK with a diagnosis of COPD, so it’s important to make sure that the guidelines that NICE produces reflect the best available evidence. This will help to ensure that our patients receive the best treatment.”

Influential respiratory services

Commenting on both appointments, medical director Dr Richard Grocott-Mason said: “As a specialist Trust we are well placed and have a responsibility to contribute to the national agenda in this way. Colleagues in respiratory medicine have a long and successful track record of doing this, and I am very pleased to see Andy and Nick taking on these new responsibilities.”

The Trust’spaediatric asthma service benefits from the close links between Royal Brompton and the National Heart and Lung Institute at Imperial College. Our service recognises that severe asthma is a far more complex problem than simply disordered airway function.

Our multidisciplinary team – comprising specialist nurses, psychologists and physiotherapists as well as doctors – looks after the full range of a young patient’s needs, and is the reason why children come from all over England for assessment at Royal Brompton.

COPD is a major cause of ill-health in England and Wales, and Royal Brompton offers a world-class, multidisciplinary service to patients from across the country – with particular expertise in non-invasive ventilation, interventional bronchoscopy and surgical intervention, as well as studying the causes and distribution of COPD.